Does Medicare Cover Home Health Care?

Does Medicare Cover Home Health Care?

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Original Medicare pays the complete cost of home health care services for beneficiaries enrolled in both Part A and Part B. You pay no deductible or coinsurance for home health care with Original Medicare.

On the other hand, Medicare Advantage plans may charge out-of-pocket costs and limit access to home health benefits. For home health care services specifically, Original Medicare offers the highest level of coverage available.

Does Medicare cover home health care?

Original Medicare covers eligible home health services when ordered by a doctor. Both Part A and Part B cover these home care services:

  • Physical therapy
  • Occupational therapy
  • Speech-language pathology services
  • Medical social services
  • Intermittent home health aides for personal hands-on care
  • Prescribed injections for women with osteoporosis
  • Medical supplies such as wound dressings when ordered by your doctor

Medicare also covers part-time or intermittent care when you require the skills of a nurse. There are limits to how long you can receive skilled care:

  • Fewer than seven days each week
  • Fewer than eight hours per day
  • 28 or fewer hours each week (or up to 35 hours a week in limited situations)
  • A 21-day period with possible extensions based on doctor recommendations
  • Homemaker services or custodial care, such as bathing or personal hygiene, only when provided as part of other approved care.

Medicare Part A covers the first 100 days of home health care after you are in a hospital or skilled nursing facility for at least three days in a row. You must be homebound and need skilled care, and you must begin to receive home health services within 14 days of your discharge.

Home health care is covered under Medicare Part B in most circumstances. With Part B, you also must be homebound and need skilled care, but a prior hospital stay is not required.

If you need continued home health care after your Medicare Part A benefit expires, Part B covers all additional approved services.

Medicare does not pay for 24-hour care or home meal deliveries.

Who qualifies for home health care services with Medicare?

You are qualified for home health services if you have both Medicare Part A and Part B. You also must be homebound, under a doctor’s care and need at least one of the Medicare-covered services.

How much does Medicare pay for home health care?

Whether your home health care is covered by Part A or Part B, Medicare pays the full cost of services furnished by a participating provider. This means you don’t pay any deductibles or coinsurance toward your home care if you and your providers follow all Medicare requirements. Except for intermittent skilled care, there is no limit to the number of home visits Medicare will cover.

Getting care from a Medicare-participating home health agency can save you money. A participating agency agrees to accept the Medicare-approved payment for services, which is usually lower than an agency’s regular fee. If you use a nonparticipating provider, the office may bill you the difference between its normal charge and the Medicare-approved amount.

How do Medigap plans cover home health care?

Medigap plans are designed to cover the 20% coinsurance left over after Medicare pays 80% of approved charges. But because Medicare covers home health care in full, there is no coinsurance to file with a Medigap plan.

However, if you need durable medical equipment such as a wheelchair or walker while receiving home care, those charges are billed separately and subject to the Medicare Part B deductible and coinsurance. If you have Medigap coverage, you pay the deductible and submit the 20% coinsurance charges to your Medigap plan for payment. Most Medigap policies cover your cost in full, but benefits vary by plan.

Does Medicare Advantage cover home health care?

Yes, Medicare Advantage plans cover home health care at the same level as Original Medicare. But Medicare Advantage plans may impose added rules, limitations and costs. Your plan may:

  • Restrict your care to plan-contracted providers
  • Require prior authorization or a referral from your family doctor on top of the mandatory Medicare certification
  • Charge deductibles, copays or coinsurance

There's only one home-care related benefit that sets Medicare Advantage apart from Original Medicare: meal delivery. But not every Medicare Advantage plan offers it, and the benefits vary by plan: For example, one plan provides meals only for patients with a specific medical diagnosis. As a result, we don't recommend choosing Medicare Advantage based on this benefit alone.

In general, we found the Original Medicare home health benefit to be the better option for home care due to full coverage and fewer potential roadblocks to receiving care. Medicare Advantage plans may limit provider choice, assess fees or require referrals and preauthorizations for care. Medicare Advantage plans add very few extras for home health care or durable medical equipment when needed as part of home care.

How do I choose a home health agency?

To organize your search, build a home health agency checklist to help narrow your options. You may want to ask, for example, if the agency accepts Medicare payment or offers the specific services you need. You can use the checklist on the Medicare.gov website or create your own based on your personal health needs and budget.

Once you have your checklist ready, you can review home health agencies via the compare page on Medicare.gov. Click the home health services button to learn about providers near you, including quality ratings and contact information.

Frequently asked questions

Does Medicare cover in-home care by a family member?

No, Medicare generally does not pay for home care given by a family member. Your doctor must approve your home health care, which is then provided by home health agencies and professionals certified by Medicare.

Who qualifies for home health care services under Medicare?

To qualify for home health services under Medicare, you must be under a plan of care created and reviewed by a doctor. You must be homebound and need intermittent nursing care or certain therapy such as physical, speech or occupational services therapy.

How many hours of home health care does Medicare cover?

Medicare Part B limits part-time or intermittent skilled care to 28 or fewer hours each week. Care is allowed for up to 21 days, with a possible extension based on medical need. Medicare has no limits on coverage for all other approved home health services.

Methodology

Our policy recommendation is based on the option that provides Medicare beneficiaries the best combination of coverage and value. Original Medicare covers home health services in full and is our recommendation for home health coverage over Medicare Advantage, which may charge fees and require referrals. Medicare Advantage and Medigap plans reviewed were from AARP/UnitedHealthcare, Aetna, Blue Cross Blue Shield, Cigna, Humana and Kaiser Permanente. Additional sources include Medicare.gov and CMS.gov.

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Deductibles, copays, coinsurance, limitations, and exclusions may apply.

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